A new technique of surgical treatment of chronic duodenal ulcer without laparotomy by videocoelioscopy

Article Abstract:

Duodenal ulcer (loss of the membranous lining of the first portion of the small intestine) that does not respond to medical treatment may be treated surgically by vagotomy. This procedure cuts branches of the vagus nerve to reduce the amount of gastric acid secreted; truncal vagotomy may be associated with changes in stomach function. Posterior truncal vagotomy performed with seromyotomy (incision into the seromuscular wall of the stomach at a point where it cuts through the gastric nerve and denervates the anterior portion of the stomach) does not change stomach motility and emptying. A report is presented of truncal vagotomy and seromyotomy performed laparoscopically, without major abdominal incision. This minimally-invasive procedure is performed using several small abdominal incisions through which trocars (sharply pointed instruments) are inserted into the abdominal cavity. A laparoscope is inserted through one trocar and attached to a video camera allowing thorough visualization of the abdominal cavity. The surgical procedure is carried out with surgical instruments introduced through the other trocar. Ten patients underwent this procedure; the average patient age was 32 and the average duration of symptoms was 3.8 years. The operation usually took one hour to perform and there were no complications. All patients left the hospital after five days, and returned to work within 10 days. Tests of acid secretion performed one month after surgery showed an average decrease in baseline output of 79.3 percent. Two months after surgery, nine patients had complete healing of their ulcer; one patient had a small residual scar; no patients had any abdominal complaints. This procedure appears to be efficient and elegant, but requires thorough experimental practice. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Innovations, Vagus nerve, Abdomen, Laparotomy, Laparoscopy, Duodenal ulcer, Vagotomy

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Small bowel obstruction in patients with a prior history of cancer

Article Abstract:

Cancer patients who develop obstruction of the small intestine often have a poor prognosis. Surgical treatment of these obstructions may have limited success in relieving symptoms and may lead to high rates of morbidity and mortality. However, about 25 percent of patients with a prior history of cancer who develop small bowel obstruction will have conditions that are potentially correctable by surgery. A study was undertaken of 54 patients with cancer who developed small bowel obstruction to determine the usefulness of surgery versus nonsurgical treatment. The study group consisted of 332 men and 22 women; the average age was 58 years. At the time of obstruction, 26 patients were known to have recurrent cancer. Initially, 40 patients were treated nonoperatively; 11 patients (28 percent) improved. However, two weeks later surgery was performed on 37 of the patients, of whom 68 percent had obstruction due to cancer recurrence. The 30-day death rate for the 25 surgically-treated patients was 24 percent. Obstruction secondary to cancer was the only factor predictive of in-hospital death. The who were discharged from the hospital following surgery had an average survival of only 2.5 months. These results suggest that patients with a prior history of cancer who develop small bowel obstruction should initially be treated conservatively. Early surgery may be indicated in patients with no known disease recurrence. Patients with known recurrence who undergo surgery have a poor prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Intestines, Cancer, Cancer patients, Cancer recurrence, Intestinal obstruction

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